Tag Archives: inappropriate

Often in practice and in teaching, there are situations where the practitioner or tutor makes a judgement about someone else’s work. Sometimes the person has a strong feeling that the other has misjudged something, and sometimes, or maybe often, this other person’s decision is described as ‘inappropriate’.

Things that are inappropriate include jokes, touch, remarks, modes of dress, approaches to others, laughing at funerals. In the language of teenagers, ‘so cheeky!’ but in the language of mental health professionals, ‘inappropriate!’

The message, whether casual or serious, is that the person has transgressed – behaved against cultural or professional norms. Within that though, is an unspoken message, that the person calling ‘inappropriate!’ has the power to decide what’s ok, and what’s not ok, and what’s more, my way is, yours isn’t.

To me this is the exact opposite of how we should be approaching both nursing and teaching. This word has the power to exclude and disadvantage, put the other person on the wrong foot, put one person in a one-up position, the other one-down. Surely this word is the most inappropriate word for us to be using?

A funny joke?

That’s the other problem with it. It doesn’t give much clue as to what was wrong. So when I say the word itself is inappropriate, you only have the barest idea of why I say so. Me saying it, and being a teacher, is that enough? Both values and evidence are implied, but if I don’t feel like explaining, it’s implicit, well, I don’t have to. I don’t have to account for myself. Well I do and so does everybody else. This word is first of all, undemocratic, and secondly disempowering.

It doesn’t tell us anything, apart from the power differential. So if something is inappropriate, should the other person just guess why? Of course not! So if I was to go into class in a mini skirt and low cut top, there would be reasons that wouldn’t be a good idea. It would be distracting from the messages I would be trying to get across, and could undermine the mutually respectful relationship I would be hoping to establish in class. Perhaps I would also be modelling (I don’t mean this in any fashionable sense) a mode of dress that could lead to difficulties in a clinical area, where service users need clarity of boundaries. But I can imagine if I were to dress like that, I would hear that it was inappropriate. I might realise that I was in the wrong but would not have clear guidance on what was not ok about my behaviour, or how to put it right. So my second point is that inappropriate is lazy. Teachers need to clarify things for students, likewise nurses for service users, it’s part of our accountability and duty to be there for others’ development. It’s what we’re paid for, and not to do so is fraudulent.

So values too are undermined by use of this word. (I’m getting sick of writing it now, and it’s also quite hard to spell.) By implying something is wrong, we are clearly calling on our value system. I shouldn’t wear revealing clothing in class – but who says, and why not? Well, it would make other people uncomfortable, distract them, and undermine my professional position and relationships. It wouldn’t be fair.

Breakfast on the commode anyone?

When I was a student nurse one of my ‘inappropriate’ decisions was to say (perhaps rather too angrily) to a nursing officer (nowadays a modern matron) that I was not ok about patients eating their breakfasts while sitting on the commode. The sister was very clear to me that this behaviour was inappropriate. Mine that is.

So here the word was used for discipline – in this profession you don’t step out of line, this is the hierarchy, this is your place. The act is not separated from the person, there is no option for inclusion, ‘what you did was not ok, but you are’. The cultural element implied means that the person feels that if you want to be one of us, you have to act just like us. There is not space for non-conformity, alternative opinions, discussion. To me this system is one of the most damaging aspects of nursing, the risk that we reinforce what’s ok and not ok in relation to a vague but strong idea of appropriateness which is culturally reinforced through generations, but because not explicit, is difficult to challenge.

I did learn from this, that if you want to change things in the NHS, it’s better to do it from the inside. At that moment I felt very much the outsider, frowned upon from all quarters. Yet really, the behaviour that was inappropriate here, people eating food on top of … well do you want to tell me I’m inappropriate if I write it? And of course inappropriate doesn’t even cover it – humiliation injustice and dehumanization, this practice arose because of understaffing and all round under-resourcing. So not only does the word not deal with the issues, it colludes with the cover-up of what’s really wrong.

Equal voices and respect?

So, I’m asking you, my colleagues as teachers, nurses and nurses to be, let’s sack this word, it is harming us, and harming those we are planning to help. It’s disempowering, excluding, unjust, makes things unclear, and contributes to a negative nursing culture. Instead we need to take the long road. This will mean stopping to think about our values, norms and expectations, and whether we can justify these, and taking the trouble to account for ourselves. In the end our destination will be fairer, more equal and inclusive, a nursing culture where we can all challenge supportively and take opportunities to develop as ourselves as a person and a professional, and be there in the same way for other people, aiming for equal voices and respect.

Blogroll

Carers Experts by experience
Support and Information Site For Families Friends or Relatives who provide help and support to a family member or friend with a mental health need living in the community. Carers outside of Plymouth are also welcome to contact me. I would also welcome any

Critical Psychiatry (UK)
On the site you will find papers and documents written by CPN in response to consultation documents from the National Institute for Health and Clinical Excellence in England (NICE).

Mental Health Foundation
Founded in 1949, the Mental Health Foundation is a leading UK charity that provides information, carries out research, campaigns and works to improve services for anyone affected by mental health problems, whatever their age and wherever they live.

Mental Health Update
Easy to understand summaries of research articles, all the latest information from the Department of Health and news stories from specialist journals.

Suman Fernando – personal website
This site provides information on issues around ‘race’ and ‘culture’ in relation to mental health in western multi-ethnic societies, social and mental health care in low and middle income (‘third world’) countries, racism in psychiatry.